Robotic-assisted PCI is safe and feasible for complex procedures

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CorPath
CorPath

Results from the CORA-PCI (Complex robotically assisted percutaneous coronary intervention) indicate that robotic-assisted percutaneous coronary intervention (PCI), using the CorPath system (Corindus Vascular Robotics, Boston, MA), is a safe and feasible approach to managing patients with complex lesions. According to the results, clinical success of robotic-assisted PCI was similar to that of manual PCI.

Presenting the data, in a late-breaking trial session, at the 2016 Society for Cardiovascular Angiography and Interventions (SCAI) Scientific Sessions (4–7 May, Orlando, USA), Ehtisham Mahmud (University of California, San Diego School of Medicine, San Diego, USA) reported that previous studies of the CorPath system were largely performed “on patients with simple coronary lesions”.  However, he added that 80% of lesions treated in the CORA-PCI trial were complex, “which is more reflective of contemporary interventional cardiology practice”.


In the study, consecutive robotic and manual procedures were performed by a single operator and a total of 334 PCI procedures were analysed (in 315 patients; mean age 67.7±11.8). Of these procedures, 108 (157 lesions) were robotically assisted and 226 (336 lesions) were manual.


Furthermore, in the robotic-assisted PCI group, more than 90% of the procedures were performed entirely robotically or with minimal manual assistance.


There were no significant differences in clinical success between groups: 99.1% for robotic-assisted PCI vs. 99.6% for manual PCI (p=0.64). Mahmud commented: “For the first time, we have shown nearly identical outcomes with a group of very complex patients.” However, procedure time was significantly longer with robotic-assisted PCI—44:30±26:04 minutes vs. for manual PCI 36:34±23:03 minutes (p=0.005). While this result remained significant after accounting for SYNTAX score, primary lesion length, and complexity (p=0.026), the longer procedure time was limited to the low complexity lesions. Propensity matched analysis (n=94 each group) confirmed that the longer procedure time in the robotic-assisted PCI group still resulted in comparable clinical success (98.9% vs. 100% for manual PCI; p=1.0). No increase in resource use or patient radiation exposure was reported with robotic PCI.


According to Mahmud, the data presented show that using robotic technology to perform PCI is “a viable alternative to manual PCI with the potential benefits of reducing radiation exposure and orthopaedic injuries to the interventional cardiologist”.